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Fulltext Inconclusive relationship between rheumatoid arthritis and schizophrenia: How to move forward?

Nur Shafawati AR, Sulong S, Wan Ghazali WS, Abdul Talib N, Wan Taib WR

Buletin Persatuan Genetik Malaysia, 2015;21(1):15-19.
MyJurnal

Rheumatoid Arthritis (RA) is a chronic inflammatory polyarthritis disease predominantly involving synovial tissue of the joints and characterized by destructive and debilitating arthritis (Choy et al., 2012; Weyand, 2000; reviewed by Worthington, 2005; Gabriel et al., 1999). It can cause progressive and irreversible destruction of tendons, cartilage and bone, which leads to lack of ability to perform daily activities (Singh et al., 2015). Although the aetiology of RA remains unsolved, the strength of the genetic component in RA is estimated based on familial aggregation and information about epidemiology and population prevalence (reviewed by Gregersen, 1999, Choy et al., 2012). (Copied from article).

Matched MeSH terms: Arthritis, Rheumatoid*
Influence of periodontitis on levels of autoantibodies in rheumatoid arthritis patients: A systematic review

Eezammuddeen NN, Vaithilingam RD, Hassan NHM

J Periodontal Res, 2023 Feb;58(1):29-42.
PMID: 36317493 DOI: 10.1111/jre.13065

BACKGROUND AND OBJECTIVE: Periodontitis (PD) is a dysbiotic disease of tooth-supporting structures that has been associated with various systemic diseases including rheumatoid arthritis (RA). To date, evidence demonstrated increased prevalence of RA among PD patients and postulated PD to have a role in the development of autoantibodies in RA patients. Therefore, a systematic review was conducted to assess the available evidence to ascertain the effect of PD on levels of autoantibodies in the serum, saliva and gingival crevicular fluid (GCF) of RA patients.
MATERIAL AND METHODS: The systematic review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Relevant literature was searched from PubMed, Web of Science, Scopus and Ebscohost databases from inception until 31 August 2020. The risk of bias in each study was determined based on the Newcastle-Ottawa Scale tool. Results from random-effect meta-analyses were presented as summary estimates of odds ratios (ORs) for seropositivity and standardised mean difference (SMD) of autoantibody levels with 95% confidence intervals. Sensitivity tests and meta-regression were performed to assess the robustness of the results and potential cause of heterogeneity.
RESULTS: The electronic and manual searches gathered 932 articles. Following screening and full-text assessment, a total of 29 studies were included in the analysis. Twenty-eight published observational studies were included in the quantitative analysis in the form of random-effect meta-analysis which revealed that PD was associated with anti-citrullinated proteins autoantibodies (ACPAs) and Rheumatoid Factor (RF) seropositive RA patients (OR for ACPA seropositivity: 1.82; 95% CI: 1.13-2.93) (OR for RF seropositivity: 1.53; 95% CI: 1.05-2.24). Also, RA patients with PD had increased serum levels of ACPA and RF. However, high heterogeneity among studies' results, partially ascribed to the unstandardised case definition of PD and laboratory testing of autoantibodies. Apart from ACPA and RF in serum, studies which reported on other RA-related autoantibodies, as well as autoantibody levels in saliva and GCF were scarce.
CONCLUSION: RA patients with PD tend to have greater ACPA and RF levels in their serum when compared with the RA patients without PD supporting the plausible role of PD in the development of systemic autoimmunity in RA patients.

Matched MeSH terms: Arthritis, Rheumatoid*
Fulltext Interleukin-23 and its correlation with disease activity, joint damage, and functional disability in rheumatoid arthritis

Dalila AS, Mohd Said MS, Shaharir SS, Asrul AW, Low SF, Shamsul AS, et al.

Kaohsiung J. Med. Sci., 2014 Jul;30(7):337-42.
PMID: 24924839 DOI: 10.1016/j.kjms.2014.02.010

The purpose of this study was to compare the serum interleukin (IL)-23 levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of IL-23 levels with disease activity, joint damage and functional disability in RA. Serum samples were obtained from 45 patients with RA and 45 healthy controls. The enzyme-linked immunosorbent assay method was used for quantitative analysis of IL-23. All the RA patients were assessed for disease activity based on the 28-joint disease activity score, joint damage based on modified Sharp score, and functional ability using the Health Assessment Questionnaire-Disability Index. The mean serum IL-23 level was much higher among the RA patients (24.50 ± 13.98 pg/mL) compared to the controls (5.98 ± 3.40 pg/mL; p < 0.01). There was a significant positive relationship between IL-23 levels and disease activity and questionnaire scores (p = 0.003 and 0.020, respectively). On logistic regression analysis, IL-23 levels were significantly higher in patients with moderate to high disease activity (p = 0.008, odds ratio = 1.073, 95% confidence interval = 1.019-1.130) and patients with significant functional disability (p = 0.008, odds ratio = 1.085, 95% confidence interval = 1.021-1.153). RA patients have significantly higher levels of serum IL-23. The IL-23 levels correlate well with disease activity and functional disability but not with radiographic joint damage.

Study site: Rheumatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Arthritis, Rheumatoid/blood*; Arthritis, Rheumatoid/physiopathology; Arthritis, Rheumatoid/radiography
Fulltext Intra- and Inter-observer Variability in Different Methods of Measuring Carpal Collapse

Agrawal S, Chabra T, Pandey S, Bhardwaj P

Malays Orthop J, 2019 Mar;13(1):20-24.
PMID: 31001379 DOI: 10.5704/MOJ.1903.003

Introduction: Carpal collapse of wrist occurs in disorders like rheumatoid arthritis and Kienbock's disease. Three techniques have been described to measure carpal collapse. First, the carpal height ratio (CHR), measured by dividing carpal height by 3rd metacarpal length. Second, the revised carpal height ratio (RCH ratio), measured by dividing carpal height by length of capitate. Third, capitate radius distance (CR index), measured by shortest distance between distal edge of radius and the proximal edge of capitate. The index publications describe good reliability of all these but which method out of the three is best in terms of intra- and inter-observer variability is not known. The purpose of this study was to find out which method had the least inter- and intra-observer variability for determining carpal collapse. Materials and Methods: Fifty normal wrist postero-anterior radiographs were studied by three assessors who measured CHR, RCH ratio and CR index separately. The measurements were repeated after one month by all the three observers. The results were then statistically analysed. Results: The p-value was <0.001 in all the three assessors in CR index meaning that the intra-observer variability was least in CR index. For the inter-observer variability intra class coefficient of 0.9 indicated that the CR index has the least variability. Conclusion: CR index is the most reproducible method to measure carpal collapse. The method which provides accurate measurement of carpal collapse will allow better staging of carpal disorders.

Study site: Grande Hospital, Nepal

Matched MeSH terms: Arthritis, Rheumatoid
Involvement of the kinin-forming system in the physiopathology of rheumatoid inflammation

Sharma JN

Agents Actions Suppl., 1992;38 ( Pt 3):343-61.
PMID: 1334358

Kinins are potent mediators of rheumatoid inflammation. The components of the kinin-forming system are hyperactive in RA. Excessive release of kinins in the synovial fluid can produce oedema, pain and loss of functions due to activation of B1 and B2 receptors. These receptors could be stimulated via injury, trauma, coagulation pathways (Hageman factor and thrombin) and immune complexes. The activated B1 and B2 receptors might cause release of other powerful non-cytokines and cytokines mediators of inflammation, for example, PGE2, PGI2, LTs, histamine, PAF, IL-1 and TNF derived mainly from polymorphonuclear leukocytes, macrophages, endothelial cells and synovial tissue. These mediators are capable of inducing bone and cartilage damage, hypertrophic synovitis, vessels proliferation, inflammatory cells migration, and possibly angiogenesis in pannus formation. These pathological changes, however, are not yet defined in human model of chronic inflammation (RA). Hence, the role of kinin and its interacting inflammatory mediators would soon start to clarify the detailed questions they revealed in clinical and experimental models of chronic inflammatory joint diseases. Several B1 and B2 receptor antagonists are being synthesized in an attempt to study the molecular functions of kinins in inflammatory processes (RA, periodontitis and osteomyelitis), and they represent and important area for continued research in rheumatology. Future development of specific, potent and stable B1 and B2 receptor antagonists or combined B1 and B2 antagonists with y-IFN might serve as pharmacological basis of more effective rationally-based therapies for RA. This may lead to significant advances in our knowledge of the mechanisms and therapeutics of rheumatic diseases.

Matched MeSH terms: Arthritis, Rheumatoid/physiopathology*
Fulltext Knowledge of cardiovascular disease risk in rheumatoid arthritis patients before and after educational intervention from a Southeast Asia country: Malaysia

Teoh BC, Syed Sulaiman SA, Tan BE

Arch Rheumatol, 2021 Mar;36(1):63-71.
PMID: 34046570 DOI: 10.46497/ArchRheumatol.2021.7726

Objectives: This study aims to improve knowledge on cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients using a multi- language leaflet tailored to our multi-ethnic patient population.
Patients and methods: This was a prospective study conducted in Hospital Pulau Pinang, Malaysia, between March 2015 and June 2015. Educational intervention was provided to 96 patients (11 males, 85 females; mean age 52.4±12.9 years; range, 20 to 83 years) who fulfilled the inclusion/exclusion criteria. Questionnaires to assess knowledge of CVD risk were given to patients to be answered before reading the informative leaflet, after one hour of intervention, and during their next follow-up three months from the intervention. Both the informative leaflet and questionnaires were prepared in English and then translated into Malay and Chinese languages to suit the need of local patients.
Results: Our results showed that RA patients had good knowledge at baseline regarding risk of smoking, hypertension, and hyperlipidemia on increasing CVD risk and that exercise would not damage their joints. However, they had low knowledge at baseline regarding the amount of exercise needed for lower CVD risks and risk of CVD with use of anti-inflammatory drugs in RA. Total knowledge score increased significantly from baseline immediately after educational intervention. However, total knowledge score decreased after three months compared to immediate post- intervention phase while it was still significantly higher compared to baseline. The improvement was most obvious for knowledge regarding anti- inflammatory drugs and CVD risk and knowledge regarding the number of flares and CVD risk. Our study did not find any significant association between demographic characteristics and traditional cardiovascular risk factors with knowledge of CVD risk.
Conclusion: Rheumatoid arthritis patients have low knowledge regarding their CVD risk related to their disease. The intervention of providing an informative leaflet effectively improved the knowledge of this group of patients on CVD risk particularly in the field related to RA-specific risk.

Matched MeSH terms: Arthritis, Rheumatoid
Levels of serum IgG against Porphyromonas gingivalis in patients with rapidly progressive periodontitis, rheumatoid arthritis and adult periodontitis

Yusof Z, Porter SR, Greenman J, Scully C

J Nihon Univ Sch Dent, 1995 Dec;37(4):197-200.
PMID: 8820338

Levels of serum IgG against Porphyromonas gingivalis cell sonicate were determined in patients with rheumatoid arthritis (RA) (n = 25), rapidly progressive periodontitis (RPP)(n = 25) and adult periodontitis (AP)(n = 15) and controls (HP)(n = 10) utilizing the ELISA technique. Comparison between groups showed no significant differences between the HP and RA groups and also between the RPP and AP groups. The increased levels of IgG in the RPP and AP groups were comparable. Significant differences in IgG levels were noted between HP and RPP (p<0.05) and between HP and AP (p<0.01). The differences between RA and RPP and between RA and AP were highly significant (p<0.0001). Thus it was revealed that the serum levels of IgG against P. gingivalis in RPP and AP patients were elevated, whereas the levels in RA patients were comparable to those in controls.

Matched MeSH terms: Arthritis, Rheumatoid/immunology; Arthritis, Rheumatoid/microbiology*
Localisation of citrullinated and carbamylated proteins in inflamed gingival tissues from rheumatoid arthritis patients

Lee YH, Baharuddin NA, Chan SW, Rahman MT, Bartold PM, Sockalingam S, et al.

Clin Oral Investig, 2021 Mar;25(3):1441-1450.
PMID: 32656595 DOI: 10.1007/s00784-020-03452-9

OBJECTIVES: It has been proposed that citrullination and carbamylation occur in the inflamed periodontium and could be the plausible mechanisms for the generation of antigens involved in the development and progression of RA. The purpose of this study was to determine the presence and location of citrullinated and carbamylated proteins in the gingival tissues and compare their abundance in periodontitis (PD) patients with or without RA.
MATERIALS AND METHODS: Gingival tissue samples of healthy (n = 5), PD with RA (n = 5) and PD without RA (n = 5) were collected. Specimens were formalin fixed, paraffin embedded and sectioned at 4 μm. The tissue sections were analysed for the presence of citrullinated and carbamylated proteins by immunohistochemistry. Semi-quantitative analysis was performed to quantify and compare the protein abundance between groups.
RESULTS: The number of cells containing citrullinated and carbamylated proteins with higher intensity was markedly increased in gingival tissues from PD with or without RA in comparison with healthy controls.
CONCLUSION: Inflamed gingival tissue is a potential source of citrullinated and carbamylated proteins other than synovial tissues. The extent to which the local accumulation of these proteins contributes to the pathogenesis of RA needs further elucidation.
CLINICAL RELEVANCE: If PD is a potential source of post-translationally modified proteins, untreated PD should not be taken lightly in the context of RA. Hence, addressing gingival inflammation should be viewed as an important preventive measure in the general population not only for the progression of periodontal disease but also reducing the risk of developing extra-oral comorbidities.

Matched MeSH terms: Arthritis, Rheumatoid*
Fulltext Long term treatment by mesenchymal stem cells conditioned medium modulates cellular, molecular and behavioral aspects of adjuvant-induced arthritis

Nazemian V, Manaheji H, Sharifi AM, Zaringhalam J

Cell Mol Biol (Noisy-le-grand), 2018 Jan 31;64(1):19-26.
PMID: 29412789 DOI: 10.14715/cmb/2018.64.2.5

Neuroinflammation plays a crucial role in expression of symptoms of numerous autoimmune and neurodegenerative diseases such as pain during rheumatoid arthritis. Overproduction of pro-inflammatory cytokines and activation of intracellular signaling pathways have been strongly implicated in the generation of pathological pain states, particularly at central nervous system sites and induction of spinal neuroinflammatory symptoms. The wide ranges of research to define new therapeutic approaches, including neuroimmune-modulators like stem cells are in progress. Mesenchymal stem cells conditioned medium (MSC-CM) has anti-inflammatory factors which can regulate the immune responses. The aim of this study was to investigate the effect of administration of MSC-CM on behavioral, cellular and molecular aspects of adjuvant-induced arthritis in male Wistar rats. Complete Freund's adjuvant (CFA)-induced arthritis (AA) was caused by single subcutaneous injection of CFA into the rat's hind paw on day 0. MSC-CM was administered daily (i.p.) and during the 21 days of the study after injection. Hyperalgesia, Edema, Serum TNF-α levels and p38MAPK and NF-κB activities were assessed on days 0,7,14 and 21 of the study. The results of this study indicated the role of MSC-CM in reducing inflammatory symptoms, serum TNF-α levels and activity of intracellular signaling pathway factors during different phases of inflammation caused by CFA. It seems that MSC-CM treatment due to its direct effects on inhibition of intracellular signaling pathways and pro-inflammatory cytokines can alleviate inflammatory symptoms and pain during CFA-induced arthritis.

Matched MeSH terms: Arthritis, Rheumatoid
Management of rheumatoid arthritis in clinical practice using treat-to-target strategy: Where do we stand in the multi-ethnic Malaysia population?

Tan BE, Lim AL, Kan SL, Lim CH, Ng YF, Tng SLC, et al.

Rheumatol Int, 2017 Jun;37(6):905-913.
PMID: 28389855 DOI: 10.1007/s00296-017-3705-6

To evaluate the achievement of treat-to-target (T2T) strategy in rheumatoid arthritis (RA) and identify factors associated with failed treatment target in a public rheumatology center. A cross-sectional study was conducted from June 2015 to February 2016. RA patients with disease duration greater than 2 years and under T2T for over a year were invited to the study. Demographic, clinical data, disease activity score of 28 joints (DAS28), and clinical disease activity index (CDAI) were collected in a single routine clinic visit. Treatment target was defined as DAS28 <3.2 or CDAI ≤10. Retrospective chart review was performed to determine reasons of failed treatment target. A total of 371 patients were recruited and 87.1% were female. Mean age and duration of RA were 53.5 years (SD 10.3) and 9.1 years (SD 6.6), respectively. Ethnic distribution was 49% Chinese, 27% Malay, and 24% Indian. T2T was achieved in 81.7% of the cohort. Non-Chinese ethnicity, positive rheumatoid factor, and treatment with three disease modifying anti-rheumatic drugs (DMARDs) were associated with failed treatment target. After controlling for covariates, Malay ethnicity (OR 2.96; 95% CI 1.47-5.96) and treatment with three DMARDs (OR 2.14; 95% CI 1.06-4.35) were associated with failed treatment target. There was no association between age, gender, duration of RA, BMI, smoking status, anti-citrulinated cyclic peptide, and achievement of T2T. The most common reasons of failed treatment target were inability to escalate DMARDs due to side effects (18.8%), lack of biologics fund (15.6%), and persistent disease despite optimum treatment (14.1%). T2T was successfully implemented. Malay patients need aggressive treatment adaptation to achieve optimal outcome.

Matched MeSH terms: Arthritis, Rheumatoid/diagnosis; Arthritis, Rheumatoid/drug therapy*; Arthritis, Rheumatoid/ethnology
Mechanical and functional assessment of the wrist affected by rheumatoid arthritis: A finite element analysis

Bajuri MN, Kadir MR, Raman MM, Kamarul T

Med Eng Phys, 2012 Nov;34(9):1294-302.
PMID: 22277308 DOI: 10.1016/j.medengphy.2011.12.020

Understanding the pathomechanics involved in rheumatoid arthritis (RA) of the wrist provides valuable information, which will invariably allow various therapeutic possibilities to be explored. The computational modelling of this disease permits the appropriate simulation to be conducted seamlessly. A study that underpins the fundamental concept that produces the biomechanical changes in a rheumatoid wrist was thus conducted through the use of finite element method. The RA model was constructed from computed tomography datasets, taking into account three major characteristics: synovial proliferation, cartilage destruction and ligamentous laxity. As control, a healthy wrist joint model was developed in parallel and compared. Cartilage was modelled based on the shape of the articulation while the ligaments were modelled with linear spring elements. A load-controlled analysis was performed simulating physiological hand grip loading conditions. The results demonstrated that the diseased model produced abnormal wrist extension and stress distribution as compared to the healthy wrist model. Due to the weakening of the ligaments, destruction of the cartilage and lower bone density, the altered biomechanical stresses were particularly evident at the radioscaphoid and capitolunate articulations which correlate to clinical findings. These results demonstrate the robust finding of the developed RA wrist model, which accurately predicted the pathological process.

Matched MeSH terms: Arthritis, Rheumatoid; Arthritis, Rheumatoid/physiopathology*
Fulltext Medical conditions associated with tooth loss among Saudi adults

Hamasha, Abed Al-Hadi, Almogbel, Lolowh, Alshehri, Abeer, Alssafia, Fatimah, Alghamdi, Hanan, Alajmia, Alanoud, et al.

Archives of Orofacial Sciences, 2018;13(1):16-21.
MyJurnal

Upon reviewing the literature, the prevalence of many systemic conditions such as diabetes,
hypertension, asthma and rheumatoid arthritis were reported to be high in Saudi Arabia. The relationship of these
conditions with tooth loss among Saudi population was not investigated. Therefore, the aim of the present study
is to explore the relationship between tooth loss and most common medical conditions among Saudi dental
patient. The study participants were 250 patients who were randomly selected from the College of Dentistry
database of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh, Saudi Arabia.
Participants were requested to answer self-administered questionnaires related to their demographic as well as
general health questions concerned to the presence of systemic medical conditions. Missing teeth were
determined after examining the orthopantogram radiographs and reviewing the Romexis and SALUD databases.
Descriptive statistics, independent t-test and linear multiple regression model were performed using SPSS
software. The mean number of missing teeth among the study population was 5.8 teeth per person. The mean
number of missing teeth was higher among subjects with diabetes, hypertension, rheumatoid arthritis,
cardiovascular diseases, or osteoporosis compared to healthy individuals. A multiple linear regression analysis
model revealed that diabetes, hypertension and rheumatoid were significant predictors of missing teeth among
Saudi population. These results highlight the importance of the effect of medical conditions on oral health.

Matched MeSH terms: Arthritis, Rheumatoid
Fulltext Methotrexate-associated nonalcoholic fatty liver disease with transaminitis in rheumatoid arthritis

Sakthiswary R, Chan GY, Koh ET, Leong KP, Thong BY

ScientificWorldJournal, 2014;2014:823763.
PMID: 24971392 DOI: 10.1155/2014/823763

BACKGROUND: The aim of this study was to determine the risk factors of MTX-associated nonalcoholic fatty liver disease (NAFLD) with transaminitis in a cohort of rheumatoid arthritis (RA) patients from Singapore.
METHODS: Patients who developed ultrasound proven NAFLD with transaminitis while on MTX therapy were identified. The demographic and clinical characteristics of the above patients (cases) were compiled and compared with age- and gender-matched controls who were RA patients on long standing MTX therapy without any episode of transaminitis.
RESULTS: Among the 978 patients who had received MTX, the prevalence of MTX-associated NAFLD was 4.7% (46 patients). Compared to the controls, the cases had significantly higher mean cumulative dose of MTX (4.03 ± 2.25 g versus 10.04 ± 9.94 g, P ≤ 0.05), weekly dose of MTX (11.3 ± 4.8 mg versus 13.1 ± 4.4 mg weekly, P = 0.033), and fasting blood glucose (P = 0.029). Following multivariate regression analysis, only cumulative dose of MTX remained significant (P = 0.015). Among the cases, the cumulative dose of MTX was found to have a significant positive correlation with the alanine transaminase (ALT) level (P < 0.05, standardised beta coefficient 0.512).
CONCLUSION: The cumulative dose of MTX was the only independent predictor of MTX-associated NAFLD with transaminitis.

Study site: Tan Tock Seng Hospital, Singapore

Matched MeSH terms: Arthritis, Rheumatoid/drug therapy*; Arthritis, Rheumatoid/epidemiology
Midterm outcome of the Duracon total knee arthroplasty

Yong CK, Choon DS, Soon HC

J Orthop Surg (Hong Kong), 2008 Aug;16(2):197-200.
PMID: 18725672

To present midterm results of Duracon total knee arthroplasty (TKA) performed between 1991 and 2001.

Matched MeSH terms: Arthritis, Rheumatoid/surgery
Fulltext Molecular modulators of celastrol as the keystones for its diverse pharmacological activities

Ng SW, Chan Y, Chellappan DK, Madheswaran T, Zeeshan F, Chan YL, et al.

Biomed Pharmacother, 2019 Jan;109:1785-1792.
PMID: 30551432 DOI: 10.1016/j.biopha.2018.11.051

In the recent years, much attention has been focused on identifying bioactive compounds from medicinal plants that could be employed in therapeutics, which is attributed to their potent pharmacological actions and better toxicological profile. One such example that has come into the light with considerable interest is the pentacyclic triterpenoid, celastrol, which has been found to provide substantial therapeutic properties in a variety of diseases. In an effort to further accelerate its potential to be utilized in clinical practice in the future; along with advancing technologies in the field of drug discovery and development, different researchers have been investigating on the various mechanisms and immunological targets of celastrol that underlie its broad spectrum of pharmacological properties. In this review, we have collated the various research findings related to the molecular modulators responsible for different pharmacological activities shown by celastrol. Our review will be of interest to the herbal, biological, molecular scientist and by providing a quick snapshot about celastrol giving a new direction in the area of herbal drug discovery and development.

Matched MeSH terms: Arthritis, Rheumatoid/drug therapy; Arthritis, Rheumatoid/metabolism
Fulltext Morsellized Allograft and Acetabular Reconstruction Cage: Follow â€“ up of 2 to 9 years

Abbas, A.A., Merican, A.M., Mohamad, J.A.

Malays Orthop J, 2007;1(1):5-7.
MyJurnal

We report the outcome of 32 patients who underwent total hip replacement (THR) augmented with morsellized fresh frozen femoral head allografts and acetabular reconstruction cages. Nine patients underwent primary THR and 23 patients underwent revision THR. Follow-up ranged from two to 9 years. Two most common indications for the procedures as reported in literature were rheumatoid arthritis and aseptic loosening of the hip. All but one patient achieved good outcome with radiographs showing full incorporation of bone grafts and no evidence of loosening of the implants. Morsellized bone grafting used with acetabular reinforcement devices is valuable for addressing severe acetabular deficiencies.

Matched MeSH terms: Arthritis, Rheumatoid
Mortality in rheumatoid arthritis: time to take it seriously

Arshad A, Shahid MS

APLAR Journal of Rheumatology, 2005;8(3):154-158.
DOI: 10.1111/j.1479-8077.2005.00158.x

Rheumatoid arthritis (RA) is often regarded as benign and not a serious disease. Yet patients with RA have a substantially reduced life expectancy. Patients with RA are particularly at risk of death from cardiovascular disease, infection and renal disease. A few variables are now recognized as important predictive markers, such as disease duration, severity, sex, educational level and treatment., Copyright (C) 2005 Blackwell Publishing Ltd

Matched MeSH terms: Arthritis, Rheumatoid
Fulltext Multicentre survey of rheumatoid arthritis patients from ministry of health rheumatology centers in Malaysia

Shahrir M, Shahdan M, Shahid M, Sulaiman W, Mokhtar AM, Othman M, et al.

Int J Rheum Dis, 2008;11(3):287-292.
DOI: 10.1111/j.1756-185X.2008.00379.x

Aim: This is a rheumatoid arthritis (RA) descriptive study, the first of its kind carried out in Malaysia.
Methods: This descriptive study involved 1084 RA patients' epidemiological and clinical data taken from Selayang, Putrajaya, Taiping and Seremban hospitals from June 2004 to December 2005.
Results: One thousand and eighty-four RA patients'data were analysed; 960 (88.6%) patients were female and 124 (11.4%) were male, approximately 8 : 1 M : F ratio. The majority of the patients were Indian (591; 54.5%), followed by the Malays (340; 31.4%), Chinese (126; 11.6%), indigenous (13; 1.2%) and others (14; 1.3%). Mean age was 49.6 ± 11.8 years with the youngest being 15 years and the oldest 88 years of age. Mean age for males was 52.0 ± 12.0 and females 49.3 ± 11.7 years (P =; 0.017). Most of these patients were housewives (565; 52.1%), followed by paid workers (266; 24.5%), retired patients (80; 7.4%), unemployed (76; 7.0%) and others (97; 8.9%). Mean duration of illness was 8.4 ± 6.7 years; 805 (74.3%) patients were relatively new patients (≤ 2 years illness duration) and 279 (25.7%) patients had illness duration > 2 years. Eight hundred and six (74.4%) were seropositive RA patients and 385 (35.5%) had presence of deformity. The majority of patients were treated with methotrexate (178; 16.4%), followed by combination of methotrexate, sulfasalazine and hydroxychloroquine (143; 13.2%), leflunomide (140; 12.9%), sulfasalazine (133; 12.3%) and combination of methotrexate and sulfasalazine (108; 10%).
Conclusion: In the above study, the majority of patients were female (960; 88.6%), Indian (591; 54.5%), had a mean age of 49.6 ± 11.8 years, most were housewives with a mean duration of illness of 8.4 ± 6.7 years and were treated with methotrexate (178; 16.4%). The results of the study may help Malaysian rheumaologists to understand their patients better and treat RA holistically.
Comment in: Yeap SS. Comment on: Multicentre survey of rheumatoid arthritis patients from Ministry of Health rheumatology centres in Malaysia. Int J Rheum Dis. 2009 Jul;12(2):177-8; author reply 179. doi: 10.1111/j.1756-185X.2009.01403.x. PubMed PMID: 20374340.

Matched MeSH terms: Arthritis, Rheumatoid
Nanomaterials for Nanotheranostics: Tuning Their Properties According to Disease Needs

Wong XY, Sena-Torralba A, Álvarez-Diduk R, Muthoosamy K, Merkoçi A

ACS Nano, 2020 03 24;14(3):2585-2627.
PMID: 32031781 DOI: 10.1021/acsnano.9b08133

Nanotheranostics is one of the biggest scientific breakthroughs in nanomedicine. Most of the currently available diagnosis and therapies are invasive, time-consuming, and associated with severe toxic side effects. Nanotheranostics, on the other hand, has the potential to bridge this gap by harnessing the capabilities of nanotechnology and nanomaterials for combined therapeutics and diagnostics with markedly enhanced efficacy. However, nanomaterial applications in nanotheranostics are still in its infancy. This is due to the fact that each disease has a particular microenvironment with well-defined characteristics, which promotes deeper selection criteria of nanomaterials to meet the disease needs. In this review, we have outlined how nanomaterials are designed and tailored for nanotheranostics of cancer and other diseases such as neurodegenerative, autoimmune (particularly on rheumatoid arthritis), and cardiovascular diseases. The penetrability and retention of a nanomaterial in the biological system, the therapeutic strategy used, and the imaging mode selected are some of the aspects discussed for each disease. The specific properties of the nanomaterials in terms of feasibility, physicochemical challenges, progress in clinical trials, its toxicity, and their future application on translational medicine are addressed. Our review meticulously and critically examines the applications of nanotheranostics with various nanomaterials, including graphene, across several diseases, offering a broader perspective of this emerging field.

Matched MeSH terms: Arthritis, Rheumatoid/drug therapy*
Nanomedicines for improved targetability to inflamed synovium for treatment of rheumatoid arthritis: Multi-functionalization as an emerging strategy to optimize therapeutic efficacy

Fang G, Zhang Q, Pang Y, Thu HE, Hussain Z

J Control Release, 2019 06 10;303:181-208.
PMID: 31015032 DOI: 10.1016/j.jconrel.2019.04.027

Owing to its intricate autoimmune pathophysiology and significant risks of progression to other rheumatic co-morbidities (i.e., osteoporosis and osteoarthritis), a plausible therapeutic regimen is mandatory for early-stage management of rheumatoid arthritis (RA). Nevertheless, the conventional therapeutic agents particularly the corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs) have shown grander success in the treatment of RA; however, long-term use of these agents is also associated with serious adverse events. To combat these issues and optimize therapeutic efficacy, nanotechnology-based interventions have been emerged as viable option. While, nanomedicines signposted superiority over the conventional pharmacological moieties; there are still many pharmacokinetic and pharmacodynamic challenges to nanomedicines following their intravenous or intra-articular administration. To circumvent these challenges, significant adaptations such as PEGylation, surface conjugation of targeting ligand(s), and site- responsive behavior (i.e., pH-, biochemical-, or thermal-responsiveness) have been implemented. Besides, multi-functionalization of nanomedicines has been emerging as an exceptional strategy to overcome pharmacokinetic challenges, improve targetability to inflamed synovium, maximise internalisation into the activated macrophages, and improved therapeutic outcomes for treatment of RA. Therefore, this review aims to conceptualize and recapitulate the substantial evidences regarding the pharmacokinetic and pharmacodynamic superiority of multi-functionalized nanomedicines over the naked nanomedicines for site-selective targeting to inflamed synovium and rational treatment of RA and other rheumatic co-morbidities. Pharmaceutical sustainability of the multi-functionalized nanomedicines for improved biocompatibility, profound interaction with the targeting tissue/cells/sub-cellular domain, and diminished systemic toxicity has also been pondered.

Matched MeSH terms: Arthritis, Rheumatoid/drug therapy*

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